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Postpartum Depression

Depression among mothers in the months after delivery has surfaced as an important maternal and child health concern. Data from three states indicate that nearly 12% of women reported being moderately depressed after they delivered their baby, and 6% reported being very depressed after delivery.¹ In addition to directly influencing the emotional wellbeing of mothers, postpartum depression (PPD) has been shown to affect marital relationships, mother–infant bonding, and infant behavior.^1–4

PRAMS and Self-Reported Postpartum Depression

Data from the Pregnancy Risk Assessment Monitoring System (PRAMS) can be used to estimate the prevalence of self-reported postpartum depression (SRPPD*) and identify trends in and risk factors for SRPPD. PRAMS data can also be used to monitor progress toward meeting the Healthy People 2010 developmental objective to reduce PPD.⁵

In 2000, seven states (Alaska, Louisiana, Maine, New York, North Carolina, Utah, and Washington) collected information about SRPPD using PRAMS† (Figure 1). The following analysis is based on responses to the question, “In the months after your delivery, would you say that you were a) not depressed at all, b) a little depressed, c) moderately depressed, d) very depressed, or e) very depressed and had to get help?” The responses were collapsed into three depression categories: none (a), low to moderate (b or c), and severe (d or e).

*Because the question used in PRAMS does not correspond to a clinical definition or diagnosis of depression, we refer to this measure as SRPPD rather than PPD.

^†The Pregnancy Risk Assessment Monitoring System (PRAMS) is part of CDC’s program to reduce rates of infant mortality and low birth weight. PRAMS is an ongoing state-level, population-based surveillance system that identifies and monitors selected maternal experiences and behaviors before, during, and after pregnancy. Each state uses the same standardized protocol that involves a mail questionnaire with telephone follow-up to survey mothers who recently gave birth. Responses are then weighted to be representative of all women who gave birth in each state during that year.

Figure 1: Map of PRAMS States in 2000 that represent states with the depression question and states without the depression question.
PRAMS states in 2000 with the depression question include the following:

• Alaska
• Louisiana
• Maine
• New York, excluding New York City
• North Carolina
• Utah
• Washington

PRAMS states in 2000 without the depression question include the following:

• Alabama
• Arkansas
• Colorado
• Florida
• Georgia
• Hawaii
• Illinois
• Michigan
• Nebraska
• New Mexico
• Ohio
• Oklahoma
• South Carolina
• Vermont
• West Virginia

Figure 1 shows the 22 states that participated in PRAMS in 2000. In April 2001, 10 additional states or areas joined the PRAMS surveillance system: Maryland, Minnesota, Mississippi, Montana, New Jersey, North Dakota, Oregon, Rhode Island, Texas, and New York City.

PRAMS Data on Self-Reported Postpartum Depression

In 2000, the percentage of PRAMS respondents with severe SRPPD ranged from 5.1% in Washington to 8.9% in Louisiana; the percentage with low to moderate depression ranged from 48.9% in New York to 62.3% in Utah; and the percentage with no depression ranged from 31.0% in Utah to 44.6% in New York (Table 1).

* CI=95% confidence interval
† Data do not include New York City

Table 1: PRAMS Surveillance Data from 2000 of the Prevalence of Three Levels of Self-Reported Postpartum Depression in Seven PRAMS States

Alaska

• 39.8%, confidence interval 36.9–42.7%, reported no postpartum depression
• 54.9%, confidence interval 51.9–57.8%, reported low to moderate postpartum depression
• 5.4% confidence interval 4.1–6.7%, reported severe depression

Louisiana

• 40.8%, confidence interval 38.3–43.3%, reported no postpartum depression
• 50.3%, confidence interval 47.7–52.9%, reported low to moderate postpartum depression
• 8.9%, confidence interval 7.4–10.4%, reported severe depression

Maine

• 41.4%, confidence interval 38.2–44.7%, reported no postpartum depression
• 50.8%, confidence interval 47.5–54.1%, reported low to moderate postpartum depression
• 7.7%, confidence interval 5.9–9.5%, reported severe depression

New York

• 44.6%, confidence interval 41.1–48.2%, reported no postpartum depression
• 48.9%, confidence interval 45.3–52.5%, reported low to moderate postpartum depression
• 6.5%, confidence interval 4.7–8.3%, reported severe depression

North Carolina

• 42.2%, confidence interval 39.1–45.2%, reported no postpartum depression
• 49.4%, confidence interval 46.3–52.5%, reported low to moderate postpartum depression
• 8.5%, confidence interval 6.7–10.2%, reported severe depression

Utah

• 31.0%, confidence interval 28.1–34.0%, reported no postpartum depression
• 62.3%, confidence interval 59.3–65.4%, reported low to moderate postpartum depression
• 6.7%, confidence interval 5.1–8.2%, reported severe depression

Washington

• 41.0%, confidence interval 37.6–44.5%, reported no postpartum depression
• 53.8%, confidence interval 50.3–57.3%, reported low to moderate postpartum depression
• 5.1%, confidence interval 3.8–6.5%, reported severe depression

These data represent the responses of 453,186 women who gave birth to a live infant in these seven states in 2000; overall, 7.1% (32,176) reported severe depression after delivery and more than half (233,844) reported low to moderate depression. Women with fewer than 12 years of education, those who were Medicaid recipients, and those who delivered low-birth-weight babies were most likely to report severe depression. In addition, women who experienced physical abuse during pregnancy and women who reported emotional, partner-related, financial, or traumatic stress were more likely than other women to report being severely depressed (Table 2).

Because more than half of new mothers reported being depressed, health care providers should speak with their patients about PPD during prenatal care and well-baby visits.
 

* Alaska, Louisiana, Maine, New York, North Carolina, Utah, and Washington
† CI = 95% confidence interval
‡ The four types of stress were defined as follows:
emotional—a very sick family member had to go into the hospital or someone close to the respondent died;
partner-related—the respondent separated or divorced from her husband/partner, she argued more than usual with her husband/partner, or her husband/partner said he didn’t want her to be pregnant;
financial—the respondent moved to a new address, her husband/partner lost his job, she lost her job, or she had a lot of bills she couldn’t pay;
traumatic—the respondent was homeless, she was involved in a physical fight, she or her husband/partner went to jail, or someone close to her had a problem with drinking/drugs

Table 2: PRAMS Surveillance Data from 2000 of the Prevalence of Three Levels of Self-Reported Postpartum Depression Among PRAMS Participants in Seven States, by Selected Demographic Characteristics and Risk Factors

Overall

• 41.3, confidence interval 39.8–42.8%, reported no postpartum depression
• 51.6%, confidence interval 50.1–53.1%, reported low to moderate postpartum depression
• 7.1% confidence interval 6.4–7.9%, reported severe depression

By Age

• Less than 20, 34.0%, confidence interval 29.6–38.3%, reported no postpartum depression; 57.1%, confidence interval 52.5–61.7%, reported low to moderate postpartum depression; 8.9%, confidence interval 6.4–11.4%, reported severe depression
• Age 20–24, 37.5%, confidence interval 34.6–40.4%, reported no postpartum depression; 52.4%, confidence interval 49.4–55.4%, reported low to moderate postpartum depression; 10.0%, confidence interval 8.2–11.9%, reported severe depression
• Age 25–34, 43.2%, confidence interval 41.1–45.2%, reported no postpartum depression; 51.0%, confidence interval 49.0–53.1%, reported low to moderate postpartum depression; 5.8%, confidence interval 4.9–6.7%, reported severe depression
• Age 35 plus, 47.0%, confidence interval 42.9–51.2%, reported no postpartum depression; 47.6%, confidence interval 43.5–51.8%, reported low to moderate postpartum depression; 5.3%, confidence interval 3.4–7.3%, reported severe depression

By Race

• White, 41.1%, confidence interval 39.4–42.8%, reported no postpartum depression; 52.3%, confidence interval 50.5–54.0%, reported low to moderate postpartum depression; 6.6%, confidence interval 5.8–7.4%, reported severe depression
• Black, 42.2%, confidence interval 38.6–45.7%, reported no postpartum depression; 48.3%, confidence interval 44.7–52.0%, reported low to moderate postpartum depression; 9.5%, confidence interval 7.4–11.6%, reported severe depression
• Other, 39.2%, confidence interval 34.0–44.4%, reported no postpartum depression; 52.1%, confidence interval 46.9–57.3%, reported low to moderate postpartum depression; 8.7%, confidence interval 5.9–11.6%, reported severe depression

By Hispanic Ethnicity

• Yes, 44.9%, confidence interval 39.8–50.0%, reported no postpartum depression; 46.7%, confidence interval 41.6–51.7%, reported low to moderate postpartum depression; 8.4%, confidence interval 5.7–11.2%, reported severe depression
• No, 40.3%, confidence interval 38.7–41.9%, reported no postpartum depression; 52.6%, confidence interval 51.0–54.2%, reported low to moderate postpartum depression; 7.1%, confidence interval 6.3–7.9%, reported severe depression

By Education

• Less than 12 years, 39.0%, confidence interval 35.3–42.7%, reported no postpartum depression; 50.7%, confidence interval 46.9–54.4%, reported low to moderate postpartum depression; 10.3%, confidence interval 8.1–12.5%, reported severe depression
• 12 years, 39.2%, confidence interval 36.6–41.8%, reported no postpartum depression; 52.7%, confidence interval 50.1–55.4%, reported low to moderate postpartum depression; 8.0%, confidence interval 6.6–9.4%, reported severe depression
• More than 12 years, 43.3%, confidence interval 41.2–45.4%, reported no postpartum depression; 51.3%, confidence interval 49.2–53.4%, reported low to moderate postpartum depression; 5.4%, confidence interval 4.4–6.3%, reported severe depression

By Medicaid Recipient

• No, 43.4%, confidence interval 41.5–45.3%, reported no postpartum depression; 51.6%, confidence interval 49.7–53.5%, reported low to moderate postpartum depression; 5.0%, confidence interval 4.2–5.9%, reported severe depression
• Yes, 37.8%, confidence interval 35.4–40.2%, reported no postpartum depression; 51.7%, confidence interval 49.2–54.1%, reported low to moderate postpartum depression; 10.5%, confidence interval 9.1–12.0%, reported severe depression

By Infant Birth Weight

• Less than 2500 grams, 34.9%, confidence interval 32.0–37.7%, reported no postpartum depression; 53.7%, confidence interval 50.7–56.7%, reported low to moderate postpartum depression; 11.4%, confidence interval 9.8–13.1%, reported severe depression
• Equal to or greater than 2500 grams, 41.7%, confidence interval 40.1–43.2%, reported no postpartum depression; 51.5%, confidence interval 49.9–53.1%, reported low to moderate postpartum depression; 6.8%, confidence interval 6.0–7.6%, reported severe depression

By Physical Abuse During Pregnancy

• Yes, 16.2%, confidence interval 11.6–20.8%, reported no postpartum depression; 61.9%, confidence interval 55.1–68.7%, reported low to moderate postpartum depression; 21.9%, confidence interval 15.8–28.0%, reported severe depression
• No, 42.6%, confidence interval 41.0–44.1%, reported no postpartum depression; 51.0%, confidence interval 49.5–52.6%, reported low to moderate postpartum depression; 6.4%, confidence interval 5.7–7.1%, reported severe depression

By Emotional Stress During Pregnancy

• Yes, 36.9%, confidence interval 34.4–39.4%, reported no postpartum depression; 54.1%, confidence interval 51.5–56.6%, reported low to moderate postpartum depression; 9.0%, confidence interval 7.6–10.5%, reported severe depression
• No, 43.7%, confidence interval 41.9–45.6%, reported no postpartum depression; 50.2%, confidence interval 48.3–52.0%, reported low to moderate postpartum depression; 6.1%, confidence interval 5.2–7.0%, reported severe depression

By Partner-Related Stress During Pregnancy

• Yes, 28.8%, confidence interval 26.4–31.1%, reported no postpartum depression; 57.6%, confidence interval 55.1–60.2%, reported low to moderate postpartum depression; 13.6%, confidence interval 11.8–15.3%, reported severe depression
• No, 47.9%, confidence interval 46.1–49.7%, reported no postpartum depression; 48.4%, confidence interval 46.5–50.2%, reported low to moderate postpartum depression; 3.8%, confidence interval 3.1–4.5%, reported severe depression

By Financial Stress During Pregnancy

• Yes, 34.9%, confidence interval 33.0–36.9%, reported no postpartum depression; 55.1%, confidence interval 53.1–57.2%, reported low to moderate postpartum depression; 9.9%, confidence interval 8.7–11.2%, reported severe depression
• No, 48.7%, confidence interval 46.5–50.9%, reported no postpartum depression; 47.4%, confidence interval 45.2–49.6%, reported low to moderate postpartum depression; 3.9%, confidence interval 3.1–4.7%, reported severe depression

By Traumatic Stress During Pregnancy

• Yes, 30.7%, confidence interval 27.5–33.9%, reported no postpartum depression; 54.3%, confidence interval 50.8–57.7%, reported low to moderate postpartum depression; 15.0%, confidence interval 12.6–17.5%, reported severe depression
• No, 44.0%, confidence interval 42.3–45.6%, reported no postpartum depression; 50.8%, confidence interval 49.2–52.5%, reported low to moderate postpartum depression; 5.2%, confidence interval 4.5–5.9%, reported severe depression

Recommendations

In Guidelines for Perinatal Care,7 the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that

• Pregnant women be educated about PPD during the third trimester.
• Obstetricians/gynecologists consult with their patients about their risk for psychiatric illness during the postpartum period.

Sources of Information

1. Gross KH, Wells CS, Radigan-Garcia A, Dietz PM. Correlates of self-reports of being very depressed in the months after delivery: results from the Pregnancy Risk Assessment Monitoring System. Matern Child Health J 2002;6(4):247–53.
2. Kumar R, Robson KM. A prospective study of emotional disorders in childbearing women. B J Psychiatry 1984;144:35–47.
3. Murray L, Fiori-Cowley A, Hooper R, Cooper P. The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome. Child Dev 1996;67(5):2512–26.
4. Field T. Maternal depression effects on infants and early interventions. Prev Med 1998;27(2):200–3.
5. U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, 2000.
6. Ahluwalia IB, Merritt R, Beck LF, Rogers M. Multiple lifestyle and psychosocial risks and delivery of small for gestational age infants. Obstet Gynecol 2001;97:649–56.
7. American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 5th ed. Washington, DC: American Academy of Pediatrics, 2002.

Acknowledgments

Brooke Kinniburgh, Brian Morrow, Leslie Lipscomb, and the PRAMS Working Group
To learn more or to order copies of this publication, write or call—Centers for Disease Control and Prevention 4770 Buford Highway NE, Mailstop K-22 Atlanta, GA 30341–3717
Telephone: 770-488-6260
Learn more about PRAMS: http://www.cdc.gov/PRAMS/index.htm
Produced: June 2004

Page last reviewed: 6/22/07
Page last modified: 8/29/06
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion